June 14, 2006

Un-Freaking Believable

Public health leaders say the weight of the scientific evidence for breast-feeding has grown so overwhelming that it is appropriate to recast their message to make clear that it is risky not to breast-feed.

Ample scientific evidence supports the contention that breast-fed babies are less vulnerable to acute infectious diseases, including respiratory and gastrointestinal infections, experts say. Some studies also suggest that breast-fed babies are at lower risk for sudden infant death syndrome and serious chronic diseases later in life, including asthma, diabetes, leukemia and some forms of lymphoma, according to the American Academy of Pediatrics.

Research on premature babies has even found that those given breast milk scored higher on I.Q. tests than those who were bottle-fed.

But hey, what's the health of your baby when weighed against those all-important feelings of inadequacy?

...critics say the new campaign has taken things too far and will make mothers who cannot breast-feed, or choose not to, feel guilty and inadequate.

"I desperately wanted to breast-feed," said Karen Petrone, an associate professor of history at University of Kentucky in Lexington.

When her two babies failed to gain weight and her pediatrician insisted that she supplement her breast milk with formula, Ms. Petrone said, "I felt so guilty."

As a twenty year old first-time mother in 1979, I was well aware that not everyone can breast-feed. I was also aware (because I took the extraordinary step of reading up on the subject) that many women aren't able to nurse due to easily-remedied factors like inadequate hydration or nervous tension/fear that can be allayed by instruction and support.

If a woman is physically unable to nurse, is feeling guilty a rational response? It might be understandable, but this is why we have brains: to prevent unreasonable emotions from taking on undue importance.

Of course, many women simply choose not to nurse their babies. But apparently shielding them from the consequences of their own freely-made decisions is far more important than the health of a baby:

Moreover, urging women to breast-feed exclusively is a tall order in a country where more than 60 percent of mothers of very young children work, federal law requires large companies to provide only 12 weeks' unpaid maternity leave and lactation leave is unheard of. Only a third of large companies provide a private, secure area where women can express breast milk during the workday [Ed. note: are the women's rooms all out of order?], and only 7 percent offer on-site or near-site child care, according to a 2005 national study of employers by the nonprofit Families and Work Institute.

"I'm concerned about the guilt that mothers will feel," said Ellen Galinsky, president of the center. "It's hard enough going back to work."

To underscore the unbearable hardship associated with nursing one's own child, the Times helpfully quotes an extreme example:

For women, breast-feeding can be an emotionally charged issue, and a very personal one. Even its most ardent supporters acknowledge that they have made sacrifices.

"It's a whole lifestyle," said Kymberlie Stefanski, a 34-year-old mother of three from Villa Park, Ill., who has not been apart from her children except for one night when she gave birth."My life revolves around my kids, basically." Ms. Stefanski quit working when her first child was born almost six years ago, nursed that child until she was 4 years old, and is nursing an infant now.

You see? Once you look at the facts, it's really an impossible choice.

Posted by Cassandra at June 14, 2006 08:54 AM

Comments

Dang that Bush! With the economy soaring, and higher wages, that means that more women will be empowered, uh enslaved as stay at home moms to their post natal parasites, tied to breast pumps to feed the selfish greedy things.

Or they might be forced to take a more hands on approach and hold them close and talk baby talk.

I always have a problem with correlation studies. I have even more problems with meta studies relying on data gotten from correlation sutudies. Correlative studies is all they've got. No one has ever shown or proven causation.

But hey, who cares about getting the science right? Well, considering that I spent a third of my life training in chemistry I tend to want the science done right and get angry when people use half baked or pseudoscience for their moral crusade.

Love your kids. Do what you think is right for them. But 'overwhelming weight of scientific evidence?' That should be one of those sayings along the line of 'be wary of statements couched in terms of always or never.'

I don't think you even need studies to decide whether breast milk is better for babies than formula. If God had been ambivalent about the value of human milk for human babies, he would have created grocery stores with formula on the Infants aisle, not waited for someone to invent it.

I'm glad there is formula for sick babies and for babies whose mothers die in childbirth. But it's just stupid to think that formula is superior to a mother's milk (if that mother isn't a crack whore and is eating normal food).

Both of my sons have an inborn error of metabolism, which we discovered when the first one went into a coma at 17 months with strong ketones on his breath, a sign of starvation. He was in the hospital for a month while they searched for the reason and tried to keep him conscious off the glucose drip. Whenever they reduce the glucose, he’d slip back into the coma. The doctors told us it was good he was breastfed, because if he'd been fed formula from infancy he probably would have lived only a few weeks, dying in his sleep from starvation, since he lacks an enzyme that breaks down certain sugars that are present in formula. In retrospect, I realized that he began to lose weight when I weaned him at about 13 months, and it was 4 months later that his body couldn't take the strain any more.

When the second one was born, I knew he had it too because I smelled ketones on his breath when he was 12 hours old, a sign that he was starving already. So I was afraid to wean him, and kept nursing him until he was 18 or 20 months old and weaned himself. He began to lose weight, and 4 months later had his first near-coma, but by then I knew what to watch for and knew how to bring him back to consciousness.

All I know is that there is something in breast milk that these boys could utilize for glucose maintenance, and from the time they were weaned until they were well into grade school, keeping them conscious was my full-time concern. They were treated by a homeopath in England, and the problem went away. This is why I'm now a homeopath.

I think it was George H. W. Bush's fault, which shows how very evil the entire Bush family is. The boys were conscious during the Clinton administration.

Exactly. Any doctor will tell you (from experience, not scientific studies) that many babies are unable to digest (or even tolerate) cow's milk, much less formula.

My two boys weren't. My first used to projectile vomit when I tried it. That's why when I did finally stop nursing, they went straight to Carnation Instant powdered milk. It was the only thing that didn't make them throw up.

My first doctor felt so strongly about nursing (after I told him I was planning on it) that he gave me his HOME PHONE # and said, "Call day or night if you're ever tempted to give up".

He said my son would be a challenge to nurse because he was so large, but that given that he was a redhead and there are allergies in my family, he thought it would be the single best thing I could do for him.

While I would hardly say it's criminal not to nurse, I get really aggravated at the constant propaganda of the "...waah! what about my life?" crowd. If you're determined, you can nurse even if you work full-time. I know - I had to stop for a while until my oldest boy's bilirubin dropped. If you could do it 26, it is certainly possible now.

All my kids were breastfed until at least a year old. As to immunities/antibodies, I was told in Germany that because I had certain antibodies, they would be passed to my children to help their thymus glands stimulate antibodies in case they got sick.

The nicest thing about breastfeeding is the total convenience of the product: No need to heat, amount and quality available on demand. The one time I had to express it to save, I looked in the freezer and saw the layer of fat on the milk. I asked my German pediatritian about that. He said that that was where most of the EFAs and antibodies were stored.

My ex-wife nursed all three of our kids until they were over two. When they climbed up in her lap, raised her shirt, and unhooked her nursing bra, she figured it was time to stop.

She also worked full-time for most of that time. She pumped breast milk and froze it so I could feed them when she was gone. The best thing is, their poop doesn't stink too much when they're breast-fed.

Yeah Cricket - my boys were both 10 pound babies and by the time they were six months, they were off the growth charts.

The main reason my DR. wanted me to nurse was to pass my antibodies on, and also because I'd been taking allergy shots for two years and he said that would get passed to the baby too. And he was incredibly healthy - only got sick once his whole first year and that was just a cold.

My Grandmother told us that she realized it was time to wean my Dad, when he was a little over 2, because he started to unbutton her blouse at a Grange meeting, yelling "Tit! Tit!". Of course, my aunt was born 9 months later.

Sigh.
MDs are often wrong. They study totally different things. A first year resident hasn't studied organic chemistry for close to 7 years---i.e. even if they paid attention they've forgetten 90% of it.
Immuno proteins do not pass from the digestive tract into the child. Google it. Use Scifinder. Use Webosci. Use any research tool you want and all conclusive studies show that it just doesn't happen. Period. I'll wager my car on it.

Sorry Cricket, but your MD was wrong. It just doesn't work like that.
I'm glad you fed your kids the way you did MathMom. It may have been what saved them, maybe not(and, just as a chemist, there is no such thing as a 'strong' or 'weak' ketone. A ketone is a ketone. Breath smelling strong of ketones, which is evidence of metabolizing proteins for energy maybe, but not 'strong' ketones.). But, the necessary micronutrients and proteins are in formula. A protein is a protein. You can't tell the difference between a protein I grew in a test tube and one produced in your body. They're the same thing.

There's no clinical showing causation that breast milk leads to anything like the claims of increased intelligence, etc.. Nothing. You're all welcome to opinions and traditions and what works for you. BUt there's no causation that's been found for half the claims I've seen in the last 4 days and everything but the odor claim I've seen here. There's no scientific basis for it. None.
Some of these molecules fall all apart when subjected to the acidic conditions of the stomach(pH much less than 5, which destroys quite a few functional groups thru acid catalyzed hydrolysis. My goodness. Porphyrines, hemoglobin for example, are tremendously stable molecules and they get torn all to hell in the stomach.). That's physical fact. Find a friend who is breast feeding and put some of the milk in lime juice---which is very weakly acidic. Look at the results after twenty minutes. Then rremember that it takes hours to get out of the stomach into the intestines. The proteins just don't survive. (Ah, but we take anti-biotics, smart guy. That's what coatings and buffers are for. TO ensure that the drug actually survives passage from the stomach to the intestines where it's absorbed or intact long enough to be absorbed while in the stomach. That's why all those long and arduous tests for the biometrics of a compound are so important. We find that to get the necessary amount of drug into a body you need 5x ingested to deliver the magic level of x.).

In reptiles there is the passing on of gut bacteria and the like. The spawn eat the poo of the mother that's in the area and the bacteria is passed on. But not in humans. They've shown that proteins produced by mother don't show up in the child conclusively.

So attacking some poor woman because she chooses not to breast feed, while there's no evidence to back up the claim that she's 'harming her child', is just mean and ignorant. Silently cluck. Mentaly scold. But there's no science backing up your moral condemnation. I'll bet my freakin' car on it.

The point of this post is that trying to keep scientific research from women because, like Nancy Hopkins, they might be emotionally traumatized or feel "stigmatized" is an incredibly infantilizing and patronizing stance. It treats women as emotional creatures who, if given information, will consistently make irrational and emotion-driven decisions.

And your "MDs are often wrong." is not only true, but rather implies that perhaps we don't understand what we've been informally observing for centuries: that breastfed babies overall do better on any number of health indices than non-breastfed babies.

Just because you don't emotionally "like" a conclusion (or because science hasn't proven it to your satisfaction) doesn't mean you have the right to withhold information from others, as the women quoted in the article are advocating.

And one more thought: just because we don't know yet how to accurately measure something does not make it non-existent.

I can't count the amount of medical conventional wisdom that has been subsequently disproven simply because our ability to measure things improved; an caveat that both pro- and anti-breastfeeding advocates might wish to keep in mind.

This NIH study claims it's the nutrients in breast milk which account for the 11-pt. gap in IQ between breastfed and non-breastfed infants.

However, other studies have also shown that simply holding and gazing into an infant's eyes for longer periods also results in increased IQ, and frankly I've always thought that just as likely a factor.

You can't "prop" a breast the way you can a bottle, and most Moms who breastfeed are going to interact with their babies during mealtime much more than those who feed with a bottle.

One of the most irritating things about bottle-feeding moms to me was their almost universal desire to get the baby to hold the bottle himself as soon as possible so they could dump him in a carseat or child carrier and avoid the time-consuming necessity of actually touching their own child or talking to him or her.

Given that parent-child interaction in the first three years of life is one of the major factors in mental and emotional development, do you really want to dismiss this out of hand?

I'm glad you fed your kids the way you did MathMom. It may have been what saved them, maybe not(and, just as a chemist, there is no such thing as a 'strong' or 'weak' ketone. A ketone is a ketone. Breath smelling strong of ketones, which is evidence of metabolizing proteins for energy maybe, but not 'strong' ketones.).

Oooh, I love someone who talks Chemistry! Thanks for your well-reasoned reply to our little chat over the last few days.

You certainly have me on a technicality, although it's a grammatical one. My son's breath smelled "strongly" of ketones, to be precise, and I blush to read my post and see my awful sentence construction. :)

However, I have a very delicately calibrated nose after years of trying to keep my children conscious, and when I can smell ketones on my child's breath from 4 feet away, I know we're in deep weeds (strong ketones). If I have to ask him to breathe directly on my nose to check for them, I know we're just starting to get in trouble (weak ketones).

I have in my hand a container of Bayer Keto-Diastix Reagent Strips for Urinalysis (well, to be precise, I have it next to my keyboard, but I liked the historical sound of that). It has a scale on the label for reading the concentration of ketones in urine. By referring to "strong" ketones, I hope you will now understand that I meant "strongly concentrated". Some reagent strips show ketone concentration as +, ++, or +++. As my pediatrician said one time when my son had been spilling (meaning in his urine) +++ ketones for three days and had lost over 10% of his body weight in that time, "You can't spill triple-plus ketones for that long without getting into trouble!", a sentiment with which I agreed.

Back to my Bayer Keto-Diastix. The scale on this lable reads in mg/dL, from Negative, to Trace (5 mg/dL), Small (15 mg/dL), Moderate (40 mg/dL) and Large (80 and 160 mg/dL). From this method of labeling, the person reading literally would think Bayer measured ketones not by their strength (Wimpy to SuperHero) but by their physical size (Petite, anyone?)

My son can spill ketones in the 160 mg/dL range even now when he is ill, but when he was a little 50-lb lad and would "go ketotic" as we referred to the situation, spilling that concentration of ketones was life-threatening, especially when he was not stressed by fever, but just having something in his metabolic idiosyncracy flip out and join the other side.

Since he was hospitalized for so long, and seen by pediatric specialists of all stripes who see babies die every day, when they told me that babies die from the inborn errors before they even have a chance to be diagnosed, I believed them. A child with hereditary fructose intolerance, or glycogen storage disease, or on of the other errors, put on formula as a newborn may die in just a few days, and the cause may appear to be crib death until the assays come back from the pathologist and labs. And when they said that breast milk probably saved him, I figure they know what they're talking about.

As to MDs frequently being wrong, who am I to disagree? Even the name for the largest blood vessel in the body, the aorta, means comes from the word "to suspend" because it was believed at one time that the function of the aorta was to suspend the heart in the body. Now we know more about its function, but we didn't rename it.

As to your argument about the impossibility of immmunity being passed to an infant through his mother's milk and similar impossibility of IQ differences based on method of feeding, and your willingness to bet your car on it, what do you drive? It may be a while before this argument can be settled to the satisfaction of both of us, indeed your car may be a classic by then and you may be driving it in parades, but science marches on and more precise methods of analysis are constantly being developed. DNA tests can now free people convicted of felonies based on the best scientific analysis of the evidence at the time of their trial, but now proven to be inadequate.

I think breast feeding is a good idea, but I did it out of laziness. I didn't want to sterlize bottles. Later I was convinced of other benefits besides convenience, but we can disagree as to whether I'm full of it.

ry,
I beg to differ on the passing of immunities to babies. Immunities are in blood and blood helps to make breast milk, along with the hormones and equipment necessary.

My cousins are retired family practice doctors. Both of them also told me that whatever Mom gets, baby gets, via milk or the umbilical cord, until the baby is weaned.

As to protein differences, I still beg to differ.
I don't have the science or chem background to make my case, but babies hork formula all over a parent if they can't digest it, either due to lack of certain acid complexes to break down minerals or enzymes to break down proteins, and sometimes both.

I have also donated milk for preemies because they couldn't handle ruminant or soy based formulas, even the predigested ones like Nutramagen, Pregestimil and Carnation Good start, which are the three best ones on the market.

None of my children have gotten sick during the time I nursed them...that can't always be said about formula fed babies.

I also know what is meant by weaning as soon as they can help themselves to the snacks no matter where you are.

My cousins are retired family practice doctors. Both of them also told me that whatever Mom gets, baby gets, via milk or the umbilical cord, until the baby is weaned.

Hi Cricket -

This reminds me of my wise old pediatrician in Alaska. He said to me once, "I learned x in Med School, but Grandma Zartmann (his wife) raised 6 children, and she says y. I do what Grandma Zartmann says."

My great San Antonio pediatrician also told me that it took him a long time to understand it, but you learn an awful lot by listening to the mothers.

I have an excellent child care book by Dr. Robert Mendelssohn entitled "How To Raise a Healthy Child In Spite Of Your Doctor." He says the same thing, that the grandmothers and mothers were smarter than the doctors, and reiterated the premise that doctors are trained to intervene. He also said that new mothers had better instincts than the trained fellas because they were in tune. And now science is starting to find out why.

He also wrote "Confessions Of A Medical Heretic" and was an advisor to those La Leche League breastfeeding fanatics on the national level.

One step further: We had a welfare cat deliver her litter of kittens at our house about a month ago. She herself was barely out of kittenhood when she decided to worm herself into my heart.

She has done the most amazing things by instinct that was all medically sound. She is in the process of weaning her little brood and I have the vet on speed dial.

But to watch her take care of her little ones has been so interesting...she stole a steak from off the counter to drag back to her babies once she decided to wean them.

I nursed my kids because of laziness too, but then again, I also did a lot of research and while we did have a can of Good Start on hand, it never got used before the expiration date.

Yeah, I tend to go with biology over chemistry in these matters myself. We may not know all there is to know about the composition of breast milk. Yeah a protein is a protein, but maybe it ain't all about the protein. Maybe its something else that we don't know about yet.

Millions of years of evolution, or a few decades of lab work? I know which I'm choosing.

Heh. If I had a dime for every stupid thing I've been told by a physician, I'd be rich. But on the other hand, I'm damned happy to have them around when something goes wrong because they know a lot. They just don't know (or understand) everything about physiology or the mind-body connection, and the good ones freely admit this.

My great San Antonio pediatrician also told me that it took him a long time to understand it, but you learn an awful lot by listening to the mothers

What he said. I run like hell when I run into a doctor who won't listen at all.

You also learn a heckuva lot in 20 years of raising children, talking to other Moms, and being literally immersed in baby talk for years at a time. I wanted very much to be a doctor when I was a child, so all my life I've read everything I could put my hands on about medicine and health, and I paid very close attention to what was going on with my kids, friends, and neighbors.

You begin to see patterns in two decades of watching and listening. You also learn that every person reacts uniquely to factors like illness and stress, so while general rules are helpful there are always exceptions.

He couldn't even say "nursing" or "breastfeeding". Conversations with him were an incredibly stilted affair where he'd ask oblique questions like "So... what is he eating these days?", to which I'd reply innocently, "Why, milk of course" in a sadistic attempt to get him to utter my favorite phrase... "on the bosom". :D

It was all I could do, even at 20, not to laugh out loud when I finally forced him to say that hateful phrase.

For anyone who's interested, here's a nice compendium of studies showing the health benefits of nursing:

http://www.breastfeeding.com/all_about/all_about_ear.html

A 1990 study found that the antibody levels of immunized infants were significantly higher in breastfed babied than in formula-fed babies. These findings are strong evidence that breastfeeding enhances the active humoral immune response in the first year of life.
Source: Papst, H.F. , Spady, D.W. "Effect of Breast Feeding on Antibody Response to Conjugate Vaccine". Lancet, 1990

Human milk can transfer specific or nonspecific immunities to the external mucosal surface of the intestine and possibly to the respiratory tract of the newborn. The acquisition of such passive immunity is particularly important in the early neonatal period when the immune system is immature. Chang, S.J. "Antimicrobial Proteins of Maternal and Cord Sera and Human Milk in Relation to Maternal Nutritional Status". A. M. J. CLIN NUTR, 1990.

And for whatever it may be worth, while I have strong opinions on the value of nursing, I have no desire to impose it (or my opinions) on that matter on the unwilling.

What does frost me, however, is when some Nanny-stater wants to prevent me from learning all I can about a subject because they don't think they can "trust" me to make rational decisions with it.

That was the point of this post; that, and the fact that none of these women seriously disputed the science (which is another argument entirely). The point is that they aren't even bothering to ARGUE that breastfeeding isn't better for babies.

They just place Mom's "feelings" far above the welfare of innocent babies, and frankly I find that reprehensible.

Even the name for the largest blood vessel in the body, the aorta, means comes from the word "to suspend" because it was believed at one time that the function of the aorta was to suspend the heart in the body. Now we know more about its function, but we didn't rename it.

I forgot to mention that even though our understanding of the function of the aorta was incorrect, the aorta was not impacted by our incomplete understanding. It works like it always has. Similarly, we may think that a manufactured formula has everything that human milk has and so will function perfectly in the human baby, but it's more likely that there is a lot yet to be understood about human milk.

The one item about human milk is that it is unique to the person and has just what that baby needs.
DNA can't be too far wrong in composing the type of milk just for that baby, and maybe that is where some of the mystery of human milk comes in.

One of my best friends told me that variations in humans with regard to milk production was as wildly variable as it was with non human mammals.

*laughs* In the course of three childen, my mom used one bottle. For me. Fruit juice, on the ONE time I was being an utter brat and about the time she became pregnant with baby #2, my sister Mouser.
I think a large part of breast feeding is folks being uncomfortable with gals nursing. Mom had a blanket that she always carried around, and when we fussed, she'd nurse us. Very polite, very covered, but oy you should see how folks react at the IDEA that someone is FEEDING their BABY from their BODY! *rolls her eyes*

From many years living and working on a ranch, I can tell you that mommie food is better than bottle food. *Grin* Our leppies (foster/orphan/abandoned) calves are usually very healthy if they manage to survive the first few weeks. And we still don't have anything to replace first milk. (Can't recal the name right now, it's yellowy and thick like syrup, though, and calves tend to die if we don't get some into them, even with all the effort we can put forth)

And I'm something of a fanatic about nursing. No, I don't believe in making people feel guilty if they won't/can't nurse, but I also really believe in education on the subject and then people can make up their own minds and it ought to be their choice.

I had the flip experience where people tried to make me feel guilty/discourage me from nursing. Thank God my Mom and my baby's first pediatrician were supportive. I had a difficult time with my first b/c he was such a big baby and required about twice as much milk as most newborns.

I had more than enough to feed him, but his bilirubin count was elevated at first and they made me put him on formula for a while until it went down. I was pretty tiny then - only about 114 lbs because I was having trouble keeping my weight up while nursing so much - my chest was already pretty enormous before that (especially in comparison to the rest of me) but for about two weeks I was walking around looking Anna Nicole Smith :p